Getting the Weight Off

By Pamela Babcock Jan 1, 2008
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HR Magazine, January 2008Employers can choose from a variety of programs to help workers lose weight, but results remain elusive.

The NBC television reality series "The Biggest Loser" pits 18 corpulent contestants against one another as they vie for a $250,000 grand prize by trying to lose weight. Each week, another person is voted off the show for failing to pare enough pounds.

As you look around your organization, you may see employees who need to lose weight. But you don't have the option of offering a hefty sum for them to lose the pounds or firing them because they're not losing enough.

According to the U.S. Centers for Disease Control and Prevention (CDC), an estimated 66 percent of U.S. adults are overweight or obese. It's in employers' best interest to offer a weight-management component in benefits or wellness plans.

Many employees want access to diet and exercise options, which can boost morale while helping to decrease health are costs. Obesity costs U.S. companies an estimated $13 billion per year, according to the CDC. Higher costs for health insurance take up the largest percentage of that sum, at $8 billion, followed by costs for paid sick leave and life and disability insurance. Health insurance costs for overweight employees range from $5,000 to $7,800 per year, compared with an average $3,900 for employees in the normal weight range, according to a January 2007 analysis of workplace health screenings done by Kronos Optimal Health Co., a Phoenix healthmanagement company.

Being overweight constitutes a risk factor for many diseases and conditions. But experts say in most instances it's largely preventable and that weight management can be achieved through diet and nutrition guidance, fitness and exercise tips or programs, and behavioral change. "Weight-management programs can benefit all employers, regardless of their location, industry or size," says Michele Becker, vice president with Aon Consulting's Health & Benefits practice in Somerset, N.J.

At the same time, employers should recognize that researchers have yet to identify the best ways to help people lose weight and keep it off. An evaluation of commercial weight-loss programs in the January 2005 Annals of Internal Medicine states, "Few high-quality studies have assessed weight-loss programs. Many of the existing studies present the best-case scenario because they do not account for people who drop out of the programs.

"Of the programs the authors evaluated, Weight Watchers had the strongest studies to support it. The best study found that participants lost 5 percent of their initial body weight (about 10 pounds) in six months and kept off 3 percent (about 5 pounds) at two years. The authors found no published highquality studies of Jenny Craig or LA Weight Loss.

"The studies of the very-low-calorie diet, medically-based programs were of limited quality. They found that patients who stayed on the programs lost about 15 percent to 20 percent of initial body weight in six months. However, many patients dropped out of these programs. Even those who completed the program regained about half of their lost weight in one to two years after treatment. The few studies of Internet based and self-help programs were of limited quality and found that these approaches produced minimal weight loss."

Popular Trend

An estimated one-third to one-half of all U.S. employers offer a wellness program, typically including a weight-management component. In 2006, 25 percent to 30 percent of employers offered programs addressing obesity, says Seth Serxner, Ph.D., a principal in Mercer's National Health and Productivity Management Specialty consulting business in Los Angeles.

And employees seem to want such programs. When asked through health risk assessments or employee surveys what they would most like to change about their lifestyles, Serxner says, "even if they smoke, the most popular answer is to lose weight."

But while facts can be extracted from health assessments, there's a less scientific way to determine whether you need such a program. Serxner says managers can "sit around a room and look at each other and say, 'Stress and weight?' Yes, we need to do something."

Help with Diet and Exercise

Employers interested in sponsoring weight-loss programs for employees have a variety of options, such as Weight Watchers' on-site classes, Jenny Craig's discounts for employees to attend its sites for classes, plus regional programs from universities, hospitals and other health providers. Insurers such as Aetna, UnitedHealth and Cigna have weight-management content on their web sites, and many provide access to coaches, health advocates and online tracking tools for employees as part of their health plans.

Some employers alsocontract with vendors such as StayWell, WebMD and Healthways to offer online and telephone-based programs that enable employees to work with coaches to address lifestyle-management issues, including weight management. To encourage exercise, many organizations offer on-site fitness centers or membership discounts at gyms. Others sponsor campaigns, such as giving employees pedometers and having them pledge to walk 10,000 steps a day. Still others label "healthy" food in their cafeterias or vending machines, or make stairwells safer for employees who climb stairs for exercise at work.

Serxner encourages employers to make such environmental and organizational changes and focus on individual programs. "Policies about what kind of foods are made available at corporate events--for example, offering a little fruit or healthy foods when there are doughnuts-- help to send a message as well as to get individuals to be accountable." Last, Serxner says many employee assistance program vendors offer "lunch and learn" sessions on weight management, and employees can be encouraged to talk to counselors about issues such as weight.

Discounts, Yoga and More

Portland, Ore.-based Regence, a Blue- Cross BlueShield insurer, provides an on-site Weight Watchers program, a "buddy system" for support and a 35 percent discount on healthy options at its cafeterias. An employee might fork over $3.25 for grilled halibut with mango salsa, vegetables and wild rice, while a hamburger and french fries cost $5.85. "Employees tell us that it helps [them] stick to their plans and to attain their goals when they have access to healthy meals and snacks on-site, and receive a discount to boot, especially since [without such a discount] it often costs more to eat healthy foods," says Denise Johnson, director of human resources, benefits and safety at Regence.

Regence, with about 7,500 employees in Idaho, Oregon, Utah and Washington, offers a farmers' market during warmer months; healthy options in vending machines and for on-site catering; fitness centers at several offices, and fitness center discounts; classes--yoga is scheduled several times a week--and health and wellness coaches. Executives use the on-site fitness centers, setting an example for employees, Johnson says. Regence also offers social networking whereby employees blog about health issues and share information. They can earn points for taking part in healthy activities, and points can be redeemed for gift cards. The company also offers online resources, from schedules of team activities or fitness courses to healthy recipes.

Participants in health plans offered by Regence receive some of these benefits through a members-only web site. Johnson says the company's experience "indicates that there is a return on investment in terms of healthier behaviors, reduced absenteeism, and improved morale, productivity and employee engagement."

At Regence, wellness-program participation has risen to 53 percent of employees from 11 percent, and use of the employee health web site has jumped to 88 percent from 4 percent during the past two years. In 2006, 553 employees lost 6,221 pounds through Weight Watchers at Work, while health food sales doubled to nearly 70 percent of cafeteria items. And, the company's health care cost trends have been at least 20 percent lower in each of the four years from 2003 through 2006 than they were in 2002, Johnson says.

Measuring Effectiveness

About a year and a half ago, Quintiles Transnational Corp., a pharmaceutical services provider in Research Triangle Park, N.C., launched Healthy U Healthy Q, a wellness program that includes a weight-loss component. "Employees are very concerned about their weight," says Ann Skye, RN, a Quintiles manager for its wellness program, "And we do have a significant weight problem within our employee base. Actually, behind stress, being overweight and being sedentary are neck and neck [in terms of] employees' self-identified health risks."

The company offers Weight Watchers at Work. "We have literally lost a ton of weight--2,000 pounds--over a sevenyear period, and it averaged about 10 pounds per person per 12-week session," Skye says.

She says Quintiles regards Weight Watchers as "the best skill-building program in the market. They've kept up with the times and provide us with good outcome data. And we definitely wanted to stick with one vendor because of the contracting and validation system setup process."

Quintiles offers Weight Watchers companywide and provides a 35 percent subsidy for participation. Since many employees work at home, Quintiles provides the same subsidy for Weight Watchers online subscriptions and vouchers so employees can attend meetings in their communities, Skye says. Quintiles has also partnered with LiveHealthier, a Rockville, Md., healthand wellness program provider, to develop an interactive web site for employees that would contain nutrition and activity plans, food and activity databases, and unlimited e-mail access to dietitians and trainers at no cost to the employee.

"One of the hallmarks of a successful wellness program is having a lot of choices," Skye says, since "some people are group people, and others want complete independence." Some need external motivation, and others just want information.

Quintiles' three largest offices have fitness centers, and the company offers reimbursements of up to $30 per month for dues at outside fitness centers. The company holds annual health and wellness events at all offices, so employees go through a screening and get their height, weight and body mass index recorded. Employees are invited to complete health risk assessments, "so we get a lot of aggregate data," Skye explains. The company has cafeterias at its two largest offices and is working toward adding healthier items and displaying nutrition information.

Skye wants to get money into the budget to provide up to $100 to each employee who completes the healthassessment and engages in the wellness program in some way, by attending an on-site exercise class or Weight Watchers, for example, or by interacting with experts on the wellness site.

Role of Incentives

Kelly Byrd, vice president of corporate and community wellness for Kronos, says that even if the employer offers incentives or refunds to employees who complete weight-loss programs, employees should pick up part of the tab so "they have a stake in the game."

Opinions on incentives vary. Some employers provide them for the employee to complete a health risk assessment and then to enter a program that addresses diet, exercise and stress. But lately, some employers have wanted to tie incentives not just to participation but to results.

Moderate financial incentives can promote employee weight loss, according to a small-scale, short-term September 2007 study by RTI International, a social and scientific research organization in Research Triangle Park, N.C., and the University of North Carolina at Chapel Hill. During the first three months of the study, 200 participants were randomly assigned either to receive no money or to receive $7 or $14 for each percentage point of weight lost over a three-month period. Researchers found that larger financial incentives resulted in the greatest short-term weight loss.

After three months, participants who were not promised cash lost an average of two pounds, those in the $7 group lost about three pounds, and those in the $14 group lost nearly five pounds. According to the study, participants in the $14 group were 5.5 times more likely than those in the no-incentive group to lose 5 percent of their body weight, point where weight loss has clinically important health benefits.

But rewarding employees based on weight loss may be tricky from a legal perspective. It might be discriminatory not to reward people who have medical problems such as thyroid conditions that could make it especially difficult, if not impossible, for them to accomplish the weight loss being rewarded. "You have to give people an equal opportunity to achieve the incentive," Serxner says.

Behavior Change

Like many other experts, Byrd of Kronos says it's critical to take a behavioral-change approach to weight management. "Dieting alone can help achieve short-term results, but the difficulty with most diets and most weight management programs is really getting at lasting change," she says. 'To have sustainable and permanent weight loss, there needs to be a change in lifestyle, achieved by a change in behavior." Slow and steady weight loss, about half a pound to two pounds per week, is really the only safe approach to weight loss, Byrd maintains. "At the end of the program, whether it's three weeks or six months, the challenge is whether the person leaves the program with a new set of skills to help make their own decisions during difficult times," she says.

Serxner concurs: "It's not about weight, it's about health. The best message you can send people is, 'We want you to be healthy.' People come in all shapes and sizes. Yes, there is probably some weight loss that will occur from the new, healthier behaviors. But we'd much rather you focus on developing a healthy lifestyle that will help you lose weight rather than telling you to get on a scale each day."

Pamela Babcock is a freelance writer based in the New York City area.

Web Extras

SHRM article
Countering a Weight Crisis 
(HR Magazine)

Employers urged to help turn around obesity trend
(HR News)

Press releases:
Financial Incentives Help Employees Lose Weight, Study Finds
(RTI International)

Employers Tip Scales of Weight Loss Success
(American Association of Occupational Health Nurses)

Press clipping:
Which methods really work to combat obesity?
 (National Business Group on Health)

Overweight and Obesity
(Centers for Disease Control and Prevention)

Proceed With Caution

While you can tie financial or other incentives to participation in a weight-loss program, some say you should think twice before linking such incentives to results or penalizing those who fall short by charging them higher health-plan premiums. Helene J. Wasserman, an attorney at Ford & Harrison in Los Angeles, cautions that under the California Fair Employment and Housing Act, obesity can be considered a disability since there might be an underlying health condition--a thyroid or other physiological issue--that could prevent a person from losing the pounds.

"Weight-loss programs that reward employees for participation are great," Wasserman says. "But you can't have the rewards linked to results because as soon as you do, you risk running afoul of anti-discrimination laws."

"In short," Wasserman says, "You might have someone who is working their heart out, and they just can't get there."

Choosing a Vendor

There are plenty of providers of weight-management programs. The players include health plans, wellness and disease management vendors, large physician practices, hospitals, and independent physicians specializing in weight-management or obesity.

Michele Becker of Aon, a global riskmanagement and HR consulting firm, says pricing varies by program type and vendor,"making it challenging to compare programs." Per-participant costs are usually
reserved for worksite programs and "hightouch" program interventions, Becker says, and fees are quoted on a per-employee, per-month basis for general weight-management programs that have broad applicability.

Becker says careful research should be done when selecting a vendor. Factors to consider:

Demonstrated results.

Educational resources.

Whether the provider offers a health risk assessment tool and a personal feedback report.

The provider's risk-stratification process and use of predictive modeling.

Types of interventions offered, such as by mail, secure e-mail, telephone or at the worksite.

The health care coaching model-- outreach, interventions, consistency.

Technology, such as whether the provider offers a portal, personal programs and flexibility.

How well the program integrates with the employer's existing plans and vendors.

Whether the vendor offers--and can administer-- incentives.

Proven success in helping to increase participant engagement and program completion.

Plans for future initiatives or enhancements.

Willingness and method for measuring success or return on investment (ROI).

On measuring ROI, Becker offers a caveat: "There is no industry-accepted way of determining return on investment. Careful analysis and a certain degree of purchasing skepticism is prudent."

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